A Patient's Guide to Heart Surgery
Pain Management and Medication After Heart Surgery
Your pain should be mild to moderate by the time you are discharged from the hospital. To help you get up and moving, you should use your prescription medication as instructed. By the time of your follow-up appointment, your pain should be minimal. Some patients experience pains in their chest and shoulder areas and become alarmed thinking it may be angina. This pain is usually due to muscle and bone aches, but if you have any doubt, call your physician.
By effectively managing and treating pain, you will heal better, enjoy greater comfort, and have fewer complications following surgery. You will be able to start walking and doing breathing exercises sooner, which will help you get your strength back, as well as avoid problems such as pneumonia and blood clots.
Where Will I Feel Pain?
While you recover after surgery, you may feel pain, pressure or burning sensation in your chest, especially at the incision site and while the chest tubes are in place. You also may feel pain when the chest tubes are removed and you start moving around, sitting up, coughing or walking.
Besides the incision site, you also may feel pain in different parts of your body. The breathing tube that was in your throat during surgery may make your throat feel sore or scratchy. You may feel pain in your arm or leg if a vein or artery was removed. Because you are lying down during surgery and in the ICU, you may feel pain in the muscles in your chest, shoulders, and back.
Numbness of Incision Area
A few patients report that they have temporary numbness in the chest, leg or arm incision or the hand where the arterial line was placed. This is due to manipulation of the nerves during surgery. It may take several months for sensation to return.
How Will My Pain be Monitored and Controlled?
After your anesthesia wears off while you are in the intensive care unit (ICU), your pain medication will be given through an intravenous (IV) line. Once you are out of the ICU, your pain medication will probably be in the form of a pill or suppository, but may also be given through an IV line. As your nurses regularly check your vital signs (blood pressure, heart rate, temperature), they will ask you to rate your pain to make sure you are treated and as comfortable as possible.
To help your doctors and nurses better understand and help minimize your pain, they will ask you to rate your pain on a scale of 0-10. Tell them how you really feel. A rating of 0 means that you are not feeling any pain, and a rating of 10 means that you are in extreme pain. Please use the chart below to help you rate your pain.
When Should I Ask for Pain Medications?
You should tell your nurse as soon as you feel pain or discomfort before it becomes too severe. Also ask for pain medication before getting out of bed, walking, or doing breathing exercises if these activities worsen the pain. Don't hesitate to ask for pain medication, because it is harder to ease pain once it has started.
Pain Medication at Home
When you are ready to leave the hospital, your doctor may prescribe pain medication for you to take when you are home. These prescriptions may or may not be the same pain medication that you took in the hospital. Because it's important for your healing and recovery, you should take your home medication according to your doctor's instructions. Let your doctor know if you feel that your pain medication is not working, your pain increases, or if you feel that you need more pain medication to keep your pain under control.
If your pain medication makes you feel tired, drowsy, or dizzy, call your doctor. If your pain medication causes constipation, drink 8-10 glasses of water a day and eat a well-balanced diet that includes fruits and vegetables. If you are still having constipation, try a gentle laxative.
Information About Pain Medication
Morphine and Fentanyl
- Purpose: Morphine and Fentanyl are used at the hospital immediately after surgery to control severe pain.
- Side Effects: Severe drowsiness, nausea and often times constipation.
Percocet, Datocet, Tylenol #3
- Purpose: Used at home, these drugs are very effective at controlling mild to moderate pain.
- Side Effects: Drowsiness, upset stomach. Should be taken with food to lessen upset stomach.
- Purpose: Controls mild to moderate pain. Easily tolerated by most patients and rarely interact with other medications.
- Side Effects: Taking more than is prescribed can cause liver problems.
Ibuprofen (Advil), naproxen sodium (Aleve),
rofecoxib (Vioxx), celecoxib (Celebrex)
- Purpose: Nonsteroidal anti-inflammatory drugs (NSAIDS). Reduces swelling and inflammation and will relieve mild to moderate pain associated with swelling. Ibuprofen and naproxen sodium are available without a prescription but take only as directed by your doctor. Vioxx and Celebrex require a prescription.
- Side Effects: Stomach upset, dizziness. Should not be taken if you have kidney problems, a history of stomach ulcers, heart failure or are on other blood thinner medications such as Coumadin (warfarin).
Pain Medication Tips When Travelling Home
- Before leaving the hospital, have your prescriptions filled, and if possible, have a second set of prescriptions filled in case of emergency.
- Always have your pain pills with you. If you are flying, keep your pain pills with your carry-on luggage.
- Wear comfortable clothes for the trip.
- If you're a woman, wear a surgical bra.
- Take your coughing and deep breathing pillow with you.
Dealing with Pain and Using Pain Medication at Home
- When at home, always follow your doctor's instructions for taking pain or any other medication.
- Follow your doctor's instructions regarding your physical activity. You may be advised to take pain medication before any activity.
- Taking your pain medication at bedtime will help you sleep and get enough rest. If you continue to have trouble sleeping, talk to your doctor.
- Continue to use pillows to support you when you sleep and during your coughing and deep breathing exercises.
- Continue to use heating pads and other alternative methods for pain control.
- Also take your pain medication before you come to the hospital to have your sutures removed.
General Tips for Using Medication
- When at home, always follow your doctor's instructions for taking pain or any other medication.
- Try not to miss any doses and try to stick with your prescribed schedule. If you miss a dose, take it as soon as possible. If it is almost time for your next dose, do not take both the missed dose and the next dose, only take one dose.
- Learn both the generic and brand names of each medication.
- Do not take other medications unless they have been prescribed by, or discussed with one of the doctors/nurses. This is especially true for over-the-counter drugs or herbal supplements bought without your doctor's prescription.
- Store all of your medications away from heat and direct light. Do not keep medicines in the bathroom cabinet since heat and moisture can cause deterioration.
- Keep your medications in their original containers since the label on the container always shows the expiration date, the prescribing doctor, the original prescription date, and the direction for taking the medication.
- Keep all medications out of reach of children.
- If you want more information about your medication, ask your doctor or one of the nurse coordinators.
Pain Medication Frequently Asked Questions
Question: Is pain medication addictive?
Answer: As long as you take pain medication only when necessary and follow your doctor's instructions, you shouldn't be worried about becoming addicted. Studies have shown that pain medication, if taken properly, does not lead to addiction.
Question: Because of my light weight and small stature, I am easily affected by medicine. Will a normal dose of pain medication be too much for me?
Answer: If you have concerns about how much pain medication you should have, talk to your doctor before surgery. Your medication during surgery will be determined by your anesthesiologist, based on your body weight. While you recover after surgery, your healthcare team will adjust your dosage according to how you respond to pain medication.
Question: How do I know that the pain medication will be enough to control my pain?
Answer: Before surgery, your doctor and anesthesiologist will discuss with you regarding your comfort level and tolerance to pain. Honestly tell them your concerns, and they will tailor a specific pain treatment plan that will work for you.
Question: In addition to the pain medication that was prescribed, can I take my over-the-counter pain medication, like Tylenol, to help with the pain?
Answer: Always talk to your doctor before taking any other medication other than what is prescribed to you. Taking Tylenol and other over-the-counter pain medication in addition to your prescribed medicine may be too much medication and may make you sick.
Alternatives to Pain Medication
Besides medication, there are other ways that you can ease pain.
Use heating pads for muscle aches, placing a towel between your body and the heating pad. Make sure that you do not fall asleep while the heating pad is on. Do not place the heating pad against your incision sites.
Pillows will cushion your chest incision as well as help with pain during coughing and deep breathing exercises. Continue to use the pillow at home to find a more comfortable position as you sleep, as well as during your coughing and breathing exercises.
For women, pain and discomfort may be felt from the incision site being pulled by the weight of the breasts when lying down. Women should wear a non-underwire surgical bra 24 hours a day for one month after surgery. Adjustable bras that have velcro closures will support the chest as well as ease pain.
Guided imagery is a relaxation technique that relieves stress and creates a sense of peace and tranquility. It helps you quiet your mind to allow you to relax so that your body may heal and be able to better cope with stressful situations, like surgery. It can also help you deal with pain, anger, depression, insomnia and other medical problems and illnesses. If you are interested in using guided imagery, please contact your doctor.